Provider First Line Business Practice Location Address:
1766 NW 56TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98107-5218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-782-2662
Provider Business Practice Location Address Fax Number:
360-387-9349
Provider Enumeration Date:
02/26/2007